The direct inguinal hernia, a type of inguinal hernia, enters through a weak point in the fascia of the abdominal wall, and its sac is noted to be medial to the inferior epigastric vessels. Direct inguinal hernias are the same in men and women.

A direct inguinal hernia protrudes through a weakened area in the transversalis fascia near the medial inguinal fossa within an anatomic region known as the medial or Hesselbach's triangle, an area defined by the edge of the rectus abdominis muscle, the inguinal ligament and the inferior epigastric artery. These hernias are also capable of exiting via the external ring and moving into the scrotum.

When a patient suffers a simultaneous direct and indirect hernia on the same side, the result is called a "pantaloon" hernia (because it looks like a pair of pants, with the epigastric vessels in the crotch), and the defects can be repaired separately or together.

Since their abdominal walls weaken as they age, direct hernia tends to occur in the middle-aged and elderly. This is in contrast to indirect hernias which, although their etiology includes a congenital component, can occur at any age ^{[1] [2]}